Healthfulness of foods and beverages displayed at store checkouts in Southern California, 2023

Store checkouts are key retail locations that promote impulse purchases of unhealthy foods and beverages. Perris, California, became the second U.S. jurisdiction-following Berkeley, California-to adopt a healthy checkout policy to improve the nutritional quality of items displayed at checkout.

To assess the healthfulness of food and beverage facings at retail store checkouts in Perris and three neighboring Southern California cities, prior to the implementation of the policy.

Cross-sectional observational study using in-store audits on all checkout product facings at sampled checkouts.

Product-level data at checkouts were collected in June 2023 from 19 stores in Perris and 69 matched stores in Moreno Valley, Rialto, and Riverside, California. Stores included chain supermarkets, chain drugstores, chain convenience stores, chain dollar stores, chain mass merchandisers, and independent grocery stores. A total of 42,294 product facings were included in the analysis.

The main outcome was the proportion of food and beverage facings at checkout in Southern California that met the nutritional standards of Perris' healthy checkout ordinance (HCO). For comparison, the analysis also examined this proportion using Berkeley's HCO standards.

Descriptive analyses and log-binomial regression with robust standard errors clustered by store and checkout location were used to estimate the proportion of healthy food and beverage facings and compare differences by location, store type, and checkout staffing.

Only 33% of food and beverage checkout facings were considered healthy under Perris' standards, and only 22% under Berkeley's. The most common food and beverage categories at checkouts were candy (35%), gum (14%), salty snacks (13%), sugar-sweetened beverages (12%), and mints (6%). Water accounted for 2%, and fruits and vegetables for less than 1%. The percentage of checkout foods and beverages meeting Perris' standards was lowest at checkout endcaps and independent grocery stores.

Most checkout foods and beverages were unhealthy before the implementation of a healthy checkout policy. To improve checkouts, healthy checkout policies should include the entire checkout (e.g., including endcaps where most SSBs are located) and cogent nutritional standards such as those in Berkeley's HCO.